Adherence to medical advice

Welcome to the World of Health Psychology!

Hello! Today, we are diving into one of the most practical chapters in Psychology: Adherence to Medical Advice. Have you ever been given a course of antibiotics and stopped taking them as soon as you felt better? Or maybe you forgot to put on your sunblock even though the doctor warned you about skin damage? If so, you’ve experienced "non-adherence."

In this chapter, we will explore why people don’t always do what doctors tell them to do, how we can measure this behavior, and most importantly, how we can help people stay healthy by following medical advice. Don't worry if it seems like a lot to take in—we’ll break it down step-by-step!

1. What is Adherence?

Adherence is defined as the extent to which a person’s behavior (taking medication, following a diet, or making lifestyle changes) matches the advice given by a healthcare professional.

Think of it like a partnership: The doctor gives the map, and the patient chooses to follow the path. In the past, psychologists used the word "compliance," but that sounded like the patient was just "obeying" an order. "Adherence" suggests a more active choice by the patient.

Why is Non-Adherence a Problem?

If people don't follow medical advice, two big things happen:
1. Health Risks: The person doesn't get better, or their condition gets worse.
2. Financial Costs: It wastes money on unused medicine and leads to expensive hospital visits later on.

Quick Review: The Basics

Adherence = Following medical advice.
Non-adherence = Not following medical advice (e.g., missing doses, stopping early).

2. How Do We Measure Adherence?

How do doctors know if you actually took your pills? They can't follow you home! Psychologists use four main ways to measure adherence:

A. Subjective Measures (Self-Reports)

This is simply asking the patient! This can be done through interviews or questionnaires.
The Problem: People often lie or forget. This is called social desirability bias—we want the doctor to think we are "good" patients, so we say we took the pills even if we didn't.

B. Objective Measures: Pill Counting

The doctor or researcher counts how many pills are left in the bottle. If you were given 20 pills and should have taken 10, there should be 10 left.
The Problem: Patients can "cheat" by throwing pills away before the appointment (this is sometimes called "pill-dumping").

C. Objective Measures: Biochemical Tests

This involves taking blood or urine tests to see if the medicine is actually in the patient's system. It is very accurate.
The Problem: It is invasive (needles!) and expensive. It also only shows if you took the medicine recently, not if you’ve been consistent for a month.

D. Electronic Monitoring (TrackCap)

Researchers use special pill bottles with microchips in the lid (like the TrackCap). Every time the bottle is opened, the chip records the date and time.
The Problem: It’s expensive, and opening the bottle doesn't guarantee the patient actually swallowed the pill!

Memory Aid: The "S.P.B.E." Method

To remember the measures, think: Silly People Buy Electronics.
Self-report, Pill count, Biochemical, Electronic monitoring.

3. Why Don't People Adhere?

Why would someone ignore advice that is meant to help them? Psychologists have two main explanations.

A. Rational Non-Adherence

This theory suggests that patients make a logical choice not to follow advice. They weigh the costs against the benefits.
Common reasons include:
- Side effects: The medicine makes them feel dizzy or sick (Bulpitt, 1994, found that many people stop taking blood pressure meds because of side effects like impotence).
- Cost: The medicine is too expensive.
- Practicality: The treatment is too complicated or takes too much time.

B. The Health Belief Model (Becker & Rosenstock)

This model says our decision to adhere depends on several "beliefs":
1. Perceived Susceptibility: "Do I really think I'm at risk of getting sicker?"
2. Perceived Severity: "How bad would it be if I didn't take this?"
3. Perceived Barriers: "Is it too hard/painful to follow this advice?"
4. Perceived Benefits: "Will this actually work?"
5. Cues to Action: Reminders like a painful symptom or a text from the doctor.

Key Takeaway

People aren't just "lazy." They often have rational reasons (like side effects) or specific beliefs that stop them from adhering.

4. How Can We Improve Adherence?

How do we get people to stay on track? Psychologists suggest two main ways: improving communication and using behavioral techniques.

A. Improving Practitioner Style (Ley's Model)

Ley (1988) found that many patients forget what the doctor said as soon as they leave the room! To fix this, doctors should:
- Simplify: Use easy language, not medical jargon.
- Categorize: "First, I'll tell you what's wrong; second, how to treat it."
- Repeat: Say the important points more than once.
- Written info: Give the patient a leaflet to take home.

B. Behavioral Techniques

These techniques use rewards and reminders to change behavior:
- Prompts: Sending text messages or phone call reminders.
- Incentives: Giving rewards. Yokley and Glenwick (1984) found that offering a lottery prize (monetary incentive) was the most effective way to get parents to bring their children for vaccinations—it worked better than just sending a reminder letter!

Did you know?

The study by Yokley and Glenwick showed that a small chance to win money was more powerful than a simple reminder. We are often motivated by the "gamification" of health!

Summary and Tips for the Exam

1. Know your studies: Mention Bulpitt for side effects and Yokley and Glenwick for incentives.
2. Evaluate: Remember that every measure of adherence (like pill counting) has a strength (it's objective) and a weakness (patients can cheat).
3. Don't mix them up: Rational non-adherence is a choice; the Health Belief Model is about perceptions.

Quick Review Box:
- Adherence: Following advice.
- Measures: Self-report, Pill count, Biochemical, TrackCap.
- Why fail? Rational choice (side effects) or Health Beliefs.
- How to fix? Better communication (Ley) or rewards (Yokley).

You’ve reached the end of the notes! Take a deep breath—you're doing great. Psychology is all about understanding human behavior, and now you understand why even "good" patients sometimes skip their medicine!